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Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology.

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Presentation on theme: "Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology."— Presentation transcript:

1 Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of pathology

2 COPD is a group of lung diseases characterized by increased resistance to air flow due to airway obstruction. Includes; 1. Chronic bronchitis. 2. Emphysema.

3 1. Chronic bronchitis

4 * Definition: persistent productive cough for at least 3 consecutive months in at least 2 consecutive years. * Causes: Chronic irritation of the bronchial mucosa by: 1.Cigarette smoking. 2.Environmental pollution. 3.Chronic inflammation of upper respiratory tract.

5 * Pathogenesis: Chronic irritation of the bronchial epithelium by cigarette smoke, environmental chemical…etc leads to: a. Epithelial changes: Hyperplasia, squamous metaplasia and dysplasia. b. Subepithelial changes: Hyperplasia of the mucous glands (increase mucin secretion) Hypertrophy of smooth muscle (leading to bronchial spasm). In old standing cases, marked fibrosis.

6 * Gross features: The mucosa is hyperaemic, swollen and covered by mucus or muco-pus. * Microscopic examination: Bronchi & bronchioles show: a.Epithelial changes: Hyperplasia, squamous metaplasia and dysplasia. b. Subepithelial changes: Hyperplasia of the mucous glands, Chronic inflammatory cells and fibrosis. Hypertrophy of the smooth muscle.

7 * Clinical types of chronic bronchitis: 1. Simple chronic bronchitis: 1. Simple chronic bronchitis: patients have a productive cough but no physiologic evidence of airflow obstruction. 2. Asthmatic chronic bronchitis: 2. Asthmatic chronic bronchitis: in individuals demonstrating hyper-reactive airways with intermittent bronchospasm and wheezing. 3. Obstructive chronic bronchitis: 3. Obstructive chronic bronchitis: in some patients, especially heavy smokers, who develop evidence of associated emphysema.

8 * Complications: 1.Emphysema. 2.Bronchopneumonia. 3.Pulomonary hypertension and core pulmonale resulting in Rt. sided heart failure. 4.Bronchogenic carcinoma

9 2. Emphysema

10 * Definition: Permanent dilatation of air spaces distal to the terminal bronchioles accompanied by damage of their walls without obvious fibrosis.

11 Respiratory acinus = Respiratory bronchioles + alveolar ducts + alveolar sacs.

12 * Types 1.Centriacinar (centrilobular) emphysema. 2.Panacinar (panlobular) emphysema.

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15 Panacinar (panlobular) emphysema Centriacinar (centrilobular) emphysema 1. Site of involvement the whole respiratory acinus (RB+AD+alveoli) Central part of the respiratory acinus (respiratory bronchiole)

16 Panacinar (panlobular) emphysema Centriacinar (centrilobular) emphysema 2. Pathogenesis - Rare (5% of cases). - Affects young ages. - Related to congenital deficiency of anti-elastase (congenital α 1 antitrypsin deficiency). Therefore the action of elastase secreted from neutrophils and macrophages becomes unopposed. - Common (95% of cases). - Affects middle and old ages. - Related to cigarette smoking, explained by; 1. Elastase-antielastase imbalance theory: Smoking weaken the wall of air spaces by increasing elastase and decreasing antielastase via; 1. Accumulation of macrophages and neutrophils in the walls of air spaces which are the source of elastase enzyme. 2. Inhibit anti-elastase (α 1 antitrypsin) by oxidants (oxygen free radicals) secreted from neutrophils.

17 Panacinar (panlobular) emphysema Centriacinar (centrilobular) emphysema 2. Chronic bronchitis theory: - It causes emphysema by:  Accumulation of macrophages and neutrophils in the walls of air spaces with release of elastase.  Bronchial obstruction by the mucous plugs leads to increased intraluminal pressure.

18 Panacinar (panlobular) emphysema Centriacinar (centrilobular) emphysema 3. Gross features 1. Chest: Barrel-shaped chest: Increased antero-posterior diameter. Horizontal ribs. Wide subcostal angle. 2. Lungs:  Lower lobes of the lungs are first affected.  Markedly enlarged lungs.  Very light.  Pale. (due to vascular compression).  Dry. Upper lobes are first affected. Moderate lung enlargement. C/S: clusters of dilated air spaces.

19 Panacinar (panlobular) emphysema Centriacinar (centrilobular) emphysema  Consistency: feathery and pit on pressure. (due to loss of elastic tissue)  Smooth outer surface with evident rib markings.  Emphysematous bullae: coalescent wide air spaces along weak borders e.g. apex, anterior margin and free edge of the base).  C/S: diffuse areas of large air spaces.

20 Centriacinar emphysema

21 Panacinar emphysema

22 Emphysematous bollus

23 Panacinar (panlobular) emphysema Centriacinar (centrilobular) emphysema 4. Microscopic Picture 1. Alveoli are: - Few in number, increased in size, distorted in shape. - Some alveolar septa rupture and the alveolar lumens coalesce to each other. 2. Alveolar walls are: thin with compressed capillaries and arterioles. Dilated respiratory bronchioles only with normal alveolar ducts and alveoli.

24 Panacinar (panlobular) emphysema Centriacinar (centrilobular) emphysema 5. Complications I. Respiratory system: 1. Chronic bronchitis. 2. Air embolism. 3. Spontaneous pneumothorax (due to rupture of emphysematous bulla). 4. Respiratory failure. II. C.V.S: Pulmonary hypertension & Rt. sided heart failure.

25 The end


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